Kevzara — Cigna
Juvenile Idiopathic Arthritis/Juvenile Rheumatoid Arthritis – Initial Therapy
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Rinvoq LQ
- Xeljanz tablets
Initial criteria
- Patient meets the standard Inflammatory Conditions – Kevzara Prior Authorization Policy criteria; AND
- Patient meets ONE of the following (a or b):
- a) Patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq/Rinvoq LQ, or Xeljanz [documentation required]; OR
- b) According to the prescriber, the patient has heart failure, a previously treated lymphoproliferative disorder, a previous serious infection, OR a demyelinating disorder.
Approval duration
6 months